A hospital is not a health farm. For a start, the food has a terrible reputation. Seriously though, when life is on the brink, a hospital is the destination. Staff are trained and equipped to deal with a range of human mishaps, injuries and illnesses.
Healthy minded people see hospitals as a last resort, with good reason, because they are not without risk. Over the years, I have even heard people say, ‘I wouldn’t go there unless I was dying’. Cross-infection with antibiotic-resistant bacteria can occur, for example. Pain, trauma, loss, fear, powerlessness or medical incompetence make foreboding prospects. Anyone who needs acute hospital care has to surrender personal power.
If you do need to go to hospital, it’s a good idea to have a competent companion at the bedside, someone to hold a hand or advocate; to speak up if the patient is incapable. For example, if it gets frantic with other emergencies, a patient may be forgotten in a corner cubicle or left lying on a corridor trolley.
In the time of COVID-19
As if all that is not enough, the COVID-19 era has layered on a sense of weirdness. Staff have to confront an extra raft of protocols to prevent the spread of COVID Delta variant. This more contagious variant has radically raised the stakes. Its attack profile includes younger adults and even some kids. Protective clothing and other precautions can be intimidating to patients and be stressful and tiring for hospital staff. Under COVID rules, relatives and friends are frequently not allowed inside at all.
So, what can we expect as our society, businesses and travel open up, at the height of the pandemic, as planned for NSW? Government advisors reassure us that hospitals will gear up to cope with the expected increase in demand.
Another outlook comes from The Medical Journal of Australia, independent of the government. Its editor, Emeritus Professor Nick Talley has forecast ‘a tsunami of hospitalisations when Australia opens up on COVID restrictions’.
And the Australian Doctor Magazine has issued a warning. Professor Raina Macintyre and a panel of 48 pandemic experts, the Ozsage group from the Kirby Institute, stated that ‘hospitals could be swamped under the NSW Government’s “roadmap to freedom” policy’. They forecast that around Christmas, it will be code black, meaning full occupancy of intensive care. Warnings of ‘tsunamis’ and ‘swamping’ of the hospital system telegraph possible hospital conditions in the months ahead.
The usual mix of health problems is sort of forgotten in COVID task fixation. Add to this the raft of physical and mental illnesses, exacerbated by lockdown. For the ten thousand things that afflict humans, we will still need hospital services, but it’s hard to see how the system will continue providing quality service.
Even though we are less than two years into this pandemic, unfolding knowledge provides some welcome reassurances. One happy surprise is that a fully vaccinated person is unlikely to become sick enough to require admission to hospital, specifically, not to need ventilation in intensive care.
As recently as of August 13, research from the Centre for Disease Control and Prevention (CDC) in the US confirmed that vaccinated adults over 65 are 96 per cent less likely to require a ventilator and intensive care. An obverse finding is that the chance of death in unvaccinated people is greater by a factor of eleven.
A doctor’s job is not to save the world but to look to the individual interests of their patients. In this light, the best reason I can find for getting the vaccine is avoidance of the need for ventilator intervention.
Any person of advanced age, or with an underlying condition, who is sick enough with COVID to require ventilation is already in deep shit. From survivors’ stories, the outlook for a return to robust long-term health is far from rosy.
We have to talk about intensive care
Let me take you on a Cook’s tour of a ventilator in intensive care unis (ICU) because, for me, it was a central issue in vaccination decisions. Years ago, I walked the floor of a busy ICU in London. I recall our nickname for this place – ‘the Expensive Scare Unit’.
The Ventilator was a cutting edge machine in that era ,before computers. Of course, technology has improved out of sight in the digital age, but the human machine is the same. The Ventilator does not work like a Thermomix in the kitchen with predictable results. Stories published by COVID survivors who have needed ventilation confirm that the road to recovery is unpredictable or long-term when this virus gets its claws in.
It works like this
The Ventilator takes over control of natural breathing. The essence of the treatment is an intimate joining via a tube in the patient’s larynx to the machine, which provides rhythmical positive pressure inflation of the lungs. A drug modelled on Curare, a tribal South American Indian arrow poison, is used routinely to paralyse the whole body, including the diaphragm muscle, to prevent the patient from fighting with the machine.
In everyday life, even the most committed couch potato naturally exercises this diaphragm for breathing, to stay alive. On a ventilator, the diaphragm cannot exercise, and it undergoes disuse atrophy very rapidly.
Survivors of ventilation need prolonged specialist physiotherapy rehabilitation for muscle wasting in the whole body. The longer the treatment, the more complex the recovery.
By the way, a side effect from positive pressure ventilation can include clotting in the lungs. Please don’t think I’m knocking the Ventilator because this treatment has preserved many lives. It gives nature time to catch up, for example, in cases of near drowning.
But even if politicians can deliver a thousand ventilators, each machine requires a team of highly expert operators and close supervision of an unconscious patient. Meanwhile, the stress of burnout syndrome under COVID conditions is decimating these skilled staff.
For those who feel that the vaccination jab is a danger or a Bill Gates conspiracy, spare a thought for the arrow poison alternative.
On the eleventh of October, when Sydney comes out of lockdown, watch out for the stampede of bulls on fire galloping northwards. There is no time to vacillate over the vaccine, because they may be coming for you.
♦ Dr Who has written previously for The Echo and has had their credentials checked to confirm the expertise of opinion.